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Hoping for audacity

September 8, 2009 4:42 amSeptember 8, 2009 4:42 am

President Obama will give his big health-care speech tomorrow. Let’s hope he does it right.

What does that mean? It means not playing professor; it means not having the speech read as if it were written by a committee (like that woefully weak op-ed in the Times a couple of weeks back); it means showing real
passion about health care, which has been sadly lacking so far.

I, for one, won’t be obsessing about exactly which pieces of proposed reform he emphasizes — because that’s not what’s driving the politics. Americans haven’t become skeptical about
Obamacare because they’d rather shave an extra $30 billion a year off the cost; they have not, contrary to “centrist” fantasies, been turned off by the details of the stimulus plan or cap-and-trade.
What has been missing is a vision. And this is probably the last chance to supply that vision.

So what should Obama do? I am not a speechwriter, but here’s my view:

1. Make it personal: In general, I’m not big on the personal anecdotes. But right now, Obama really needs to make it clear that the horrors of our health care system can lead to nightmarish outcomes
— and that those nightmares can happen to you, or someone like you. This is the time for “Lois Lane, of Smallville, Kansas, lost her coverage when her employer went bankrupt. When she tried to get
individual coverage, she was turned down because she once had a rash in college. Then she got cancer …”

2. Talk about Medicare: Incredibly, the Obama administration has let conservatives — conservatives! — position themselves as the defenders of Medicare. Obama needs to remind viewers that Medicare
was a deeply controversial program, that there were dire warnings about what the program would do, and that the people who tried to prevent the creation of Medicare (and keep trying to dismantle it) are the very
same people now opposing health-care reform. Talk about how many Republicans voted for a resolution calling for Medicare privatization just months ago!

3. Talk about the system’s troubles: Obama really needs to convey the urgency of reform; he should talk about the doubling of premiums over the past decade and, crucially, the way ever fewer employers
are offering coverage. The message should be, even if you think your insurance is OK now, it could well be gone in a few years.

4. Explain the plan in as few words as possible: Here’s my stab at it — one hopes the speechwriters can do better, but it gets at the essence. “We’re going to make sure that every
American has access to the same insurance deals big employers get. We’re going make sure that no American can be denied coverage at a reasonable rate because of previous medical history. And for those Americans
who find it hard to afford essential insurance, we’ll provide financial aid.

“Now, there are a few things we’ll need to do to make this work. We’ll have to require that all large employers either offer coverage to their workers or pay into a fund that helps them get their
own insurance. We’ll sign people up for insurance now, even if they’re healthy, because it’s not fair to others if you wait until you’re sick to join the system. And we’ll keep
the insurance companies honest by offering people the choice of buying their insurance directly from a public plan.

“Let me be honest: this won’t come free. But this plan will give Americans the fundamental security of knowing that for the rest of their lives they and their families will have the health insurance they
need, insurance that they can’t lose.”

That’s the main thrust.

Oh, and about the public option: yes, it should be in the speech — and not just because it will lower costs. From personal discussions I know that the individual mandate really gets peoples’ hackles up,because
they see it as a giveaway to the insurance industry (you may recall that many Obama supporters made precisely that case during the primary). Yet the individual mandate is necessary — so it’s crucial
to have the counter-argument that look, people can choose the public option. Yes, some senators will fight against that option tooth and nail — but that’s for later.

What I hope Obama realizes is that this speech should not be aimed at Kent Conrad or Susan Collins. A national address is not where you do your backroom deals. This speech has to be aimed at regaining the trust of the
American people. It needs to be something with vision and sweep, not an item-by-item detailing of what the administration is prepared to concede.

This is a time for Obama to show real leadership — not to uplift the nation with vague generalities, not to sound like a technocrat, but to persuade America that it needs to change. Can he do it? Let’s
see.

I somewhat agree with the points made here, but I disagree with the general tone of what’s being suggested.

The fact is this, liberals can no longer afford the carefully scripted academic tone that Obama is accustomed to. If this speech is to work in the way it must work, it must be less Thomas Jefferson and more Andrew
Jackson. It must tear the roof off. It must drive people out of their seats with such power and authority that Obama’s critics will look petulant and weak as they try to rebut with their everyday nonsense.

Obama’s presidency is owed to the very people who were inspired enough to take to the streets, make phone calls, and march on his behalf. All he needs to do is inspire those same people to walk that same
mile again. If he can make this speech a call to action instead of a “very wise and thoughtful plan,” then people will respond.

Until and unless the POTUS is willing to put his administration on the line for this initiative – an initiative which amounts to the final completion of the New Deal (after 70 years?!) – he cannot
expect or hope for much but indifference from his liberal base.

JFK said “We’re going to the moon.” I don’t remember getting bogged down in a fight about that statement of commitment – we just got busy figuring out how to get there.

Which is why I can’t understand why the President didn’t start health care reform by declaring “We’re going to cover every American”. He left that commitment open to debate and
can’t get beyond it. Or was this lack of commitment intentional?

“Let me be honest: this won’t come free.” Correctomundo. Get ready for another very significant deduction line on your paycheck, folks. Great timing, right? In the midst of the deepest recession
since the Great Depression, our president wants to raise taxes. Phooey!

I very much agree. It’s a shame that we’ve reached this make-or-break point so early in his presidency; but that’s indeed where we are. I just hope I won’t look back at my vote for Obama
as an example of “The Mendacity of Hope”.

5. Jettison the whole thing and announce “Medicare for all”– which will be harder to attack because Medicare is a popular program– paid for by repealing Bush tax cuts, eliminating the
FICA tax, extending FICA or its equivalent to unearned income, and setting the FICA rate so that it is deficit neutral (again, removing a line of attack). Release a one page bill instead of a 1000 page bill,
leaving less to object to.

Yes, I know “single payer” has been declared to be off the table. But the President, himself, has said it is a superior path. Why compromise with an inflexible opponent who has proven that they will
demonize any proposal using the same invective? Obama will be judged by the success or failure of this bill– if he believes that single payer will be more successful, then it is in his best interest to
push that through Congress.

I haven’t always thought this way. Even a couple weeks ago, I posted a blog saying that I thought a real “public option” would be a decent, non-threatening compromise. Then, I attended a townhall.

Give up on Republican cooperation– they’ve proven this summer, through townhalls and the rhetoric of their leadership that it won’t happen– and make it clear to Democratic members of
Congress (that includes Senators) that this is a party line vote. Or else– no Presidential support, expect a primary opponent, and if you survive the primary, anticipate the President might even loosely
aid your opponent in the general.

You’re wrong. If he doesn’t tell me what’s in it for me–what I get after years of paying for my own private insurance that didn’t cover what I needed it to cover and, through my
taxes, paying for the care of people who didn’t choose to or couldn’t afford to have insurance, then I don’t want to hear it. I read the plan and spoke to my elected reps about it. They
HOPE that competition will EVENTUALLY lower my premiums, but that’s years off and NO, if your employer offers insurance you are NOT eligible to participate in the public option. The public option will
be better than my private one and I won’t be eligible for it because I have a job but I will be paying for people who don’t have a job to get better care than I can. I get it. I’m supposed
to listen to my better angels. I’m not opposed to doing so but I’m tired and I’m struggling and I’m scared. It’s bad out here in the real world and I want to know, what’s
in it for me.

I was a tepid supporter of Obama (lesser of two evils). I now think he’s too committed to “bipartisanship” (kissing the hand that smites him) to do anything of significance. And I believe
his speech will be a wishy washy mess. Oh God, I want to be wrong.

He really does have to go after those with big group plans who are reasonably well-treated by the insurance companies now, showing them how they, too, will be better off. He has got to showcase some of these ripoff
premium increases (22% in Michigan for Blue Cross) to show how the current system is becoming unsustainable.

I can never tell from the commentary on this topic whether the people who are trying to maintain the current status quo (“death panels by insurance companies”) are doing so because:

a) they hate government with a passion and therefore want to keep it away from health insurance just on principle (despite thousands of horror stories about how private industry is killing Americans through its
merciless drive for greater profitability)

b) they resent the notion of having to pay (via taxes or premiums) for something that might actually help other people more than it helps them (until such time as they themselves need it, which might be years or
decades down the road still)

c) they can’t stand the thought that the rest of the civilized world may have gotten the solution right decades before the U.S. of A. did, and therefore they see universal health insurance as an unbearable
admission of that failing on their country’s part

d) they watch Fox News and actually believe it’s “fair and balanced”

Clearly no self-respecting American could ever learn anything from his or her neighbours to the North, but when the Canadian Broadcasting Corporation recently polled those of us in the Great White North as to who
the Greatest Canadian was, some expected that a name like Wayne Gretzky, Terry Fox or Frederick Banting (discoverer of insulin) would top the list. Instead, however, it was Tommy Douglas, the politician who’s
known as “the father of Medicare” (that’s right, Medicare comes from Canada… get over it!) who came in # 1. The Canadian public got it exactly right, as there’s almost certainly
been no development in our country’s history more significant than the introduction of universal health care. We have lots to worry about here (including harsh winters), but at least when we get sick
we don’t have to stress out over the possibility of losing our homes, entering bankruptcy or having marriages fall apart because of the escalating medical bills. Nothing has improved our quality of life
here more than that, and we have the late, great(est) Tommy Douglas to thank for it.

Maybe Barack Obama will someday be voted the Greatest American, decades from now, once the current crop of crazies who think that matters of life and death ought to be left up to those chasing corporate bottom lines
have faded back into the woodwork (or at least moved on to their next target). It’s amazing how quickly you get used to something like unassailable access to health care once you get it, but it’s
nice to see that we Canadians still appreciate what we have. I’m sure that most Americans will react that same way, given half a chance.

Well said, Dr Krugman. I would like President Obama to paraphrase a line directly from FDR for the remainder of his firt term…’During the campaign they met their Match. Now they will meet their Master.”
Enough of the non-existent bipartisan out reach. Republicans, and many so-called moderate Democrats, are not interested in addressing the issues of our day, so take a leaf from President GW Bush’s book….they
are either with us or against us. That is what I would like to see tomorrow night.

No American should be forced to go without needed healthcare because their employer doesn’t provide insurance or because their insurer finds loopholes to avoid paying. Over 1/3 of our health care dollars
are wasted on administration — chasing insurance companies for compensation while they seek to push costs to someone else — or on misuse of our emergency systems because we don’t provide
easy access to routine care. Our economy is in trouble, in part, because companies cannot pay for our too expensive private insurance and compete internationally.

On point number 1 you refer to Lois Lane of Smallville Kansas. I believe you really mean Clark Kent; he’s from Smallville. Lois is from Metropolis. Other than that, everything looks good to me. Thanks.

What a lot of us have been missing since the election is the big, sweeping idea that in this country, we have a strong sense of values, which includes taking care of our citizens when times are tough for them.

The arguments against healthcare reform seem to be of the “I’ve got mine, you figure out how to get yours,” variety, which is disheartening. We need the president to take the lead on the message
that we’re all in this together.

That’s all high-level bumper sticker stuff. The people, God bless ’em, are into the other thoughts now: Who pays? What effect on seniors? Why force the young to buy what they don’t
need? Why “reform” a system that covers 300 million well to cover 10 or so million who can’t afford it? Why are drug companies behind this plan? Why are insurance companies behind
this plan? Why are unions behind this plan? How can we, who are drowning in the red ink of past go’vt entitlements plans, possibly be contemplating another?

Yes, I agree with all of the main points. But, the real issue in the selling of health care reform is countering the horrendous distortions inherent in the opposition’s viral campaign.

I know from personal experience with the Canadian (Ontario) health system that a government-run program can be made to work extraordinarily well. How can we get that point across to the general public? One speech,
however well crafted, won’t do it.